This chapter outlines the impact of antimicrobial resistance by describing the epidemiology of select antimicrobial-resistant pathogens and the difficulties associated with treatment of infections caused by these organisms. It discusses antimicrobial treatment options for infections caused by resistant enterococci, Staphylococcus aureus, Streptococcus pneumoniae, and Mycobacterium tuberculosis. The arrival of vancomycin-resistant enterococci (VRE) is often attributed to the overuse of vancomycin, which has increased about 100-fold in the last 20 years, predominantly to treat methicillin-resistant S. aureus (MRSA), enterococcal, and Clostridium difficile infections. The most important risk factors for VRE colonization and infection include severe underlying disease, extended hospital stay, and previous antimicrobial exposure. In the absence of literature supporting the use of one agent versus another, linezolid should be used as first line therapy for VRE infections, because it can cover both Enterococcus faecalis and E. faecium. No population or geographical region is immune or isolated from the risk of infection with the primary cause of tuberculosis (TB) M. tuberculosis. Vaccine candidates that have been developed so far include recombinant M. bovis Bacillus Calmette-Guérin; attenuated M. tuberculosis; subunit and pooled subunit vaccines; fusion polyproteins; and DNA vaccines.

23. Centers for Disease Control and Prevention. 2002. Campaign to prevent antimicrobial resistance in healthcare settings. Available at: http://www.cdc.gov/drugresistance/healthcare/default. htm.

24.Centers for Disease Control and Prevention.2003. Update: adverse event data and revised American Thoracic Society/CDC recommendations against the use of rifampin and pyrazinamide for treatment of latent tuberculosis infections—United States. Morb. Mortal. Wkly. Rep.52:735–739.